The purpose of this article is to explain in a basic and tangible sense, Chronic Kidney Disease or Chronic Renal Failure and End Stage Renal Disease. Chronic kidney disease, once progressive leads to end-stage renal disease (ESRD). However, in addition to this, the placing of these scientific and valuable facts here can serve as an explanatory database for anyone needing to know about these diseases, especially given the personal nature of this platform. The first elucidation is regarding Chronic Renal Failure, also known as Chronic Kidney Disease. As the word suggests, 'chronic'; incites the explanation of the illness starting at a defined point and continuing or progressing for a long period of time. The illness spirals to deterioration of the patient's vitality until End Stage Renal Disease occurs.
What is Chronic Renal Failure? It is, as described by an article published by Satyanarayana R. Vaidya; Narothama R. Aeddula, the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min which means that more than half of the glomeruli in both kidneys have been lost. Indeed, it is a state of progressive loss of kidney function ultimately resulting in the need for renal replacement therapy (dialysis or transplantation). There are complementary factors as seen posted by Javier Cotelo, MD in Medscape. They are that, in the presence of kidney injury or lesions with or without reduced filtration rate; renal biopsy, albumin/creatinine ratio >30 mg/g, proteinuria, alterations in urinary sediment, or in imaging tests. If one of these two criteria (the former being eGFR) persists for more than 3 months, the diagnosis made is chronic kidney disease. Also, high creatinine levels are not diagnostic for the disease. These terms may be challenging to understand therefore, to dissect them:
The first diagnosis factor the Glomerular Filtration Rate is the way in which each glomerulus (Figure 1)
filters the blood and its contents. The glomeruli (many glomerulus) are located all around the kidneys and the way in which your kidney functions is determined by their efficiency. According to the National Kidney Foundation, a normal glomerular filtration rate (GFR) should range from 90 to 120 mL/min. In the elderly population, it may be slightly different, but this is the general range.
The second criterion outlined above is Renal Biopsy: This is when a sample of your kidney is retrieved via a minor surgical procedure (Figure 2) and
analyzed under a microscope. The third is: Albumin/Creatinine Ratio which are both substances traced in your urine. This calculation if more than >30mg indicates kidney damage as a normal range is below 30. This simply means that your kidneys are not filtering creatinine and albumin correctly leading to creatinuria and albuminuria. Whenever you see -uria written at the end of a word it means that it is present in the urine. Alterations to urinary sediments indicate that the urine has more particles than it should have such as glucose and other vital elements which the kidneys should be reabsorbing rather than eliminating, indicating poor functionality of the kidneys' ability to decipher what is important and what should be excreted. Since in CKD more than half of the nephrons in each kidney have been lost and albuminuria informs about structural damage (i.e., the
condition of the remaining nephrons). It's therefore essential to test for both parameters. This information can assist with reading any laboratory exam received. With this understanding, the
exploration of what causes the kidney to falter in its capacity to optimally filter blood is seen below.
What causes Chronic Kidney Disease? The two main culprits are the underlying illnesses: hypertension which means high blood pressure (often written as HTN) and diabetes. If one is hypertensive or diabetic, the normal functioning of your glomeruli is damaged, disrupts the albumin creatinine ratio, causes sedimentation issues seen in urine, and has morphological (structural) abnormalities of the ailing kidneys. Other causes of CKD are Glomerulonephritis, Polycystic kidney disease, Membranous. Nephropathy, Obstruction of the urinary tract, History of acute kidney injury for patients with chronic autoimmune disease, Neoplasms, Vesicoureteral Reflux, Nephrotic Syndrome, Recurrent Kidney Infection, Diabetes-Related Nephropathy, Lupus, Precipitating factors like non-steroidal anti-inflammatory medications (NSAIDS). It is not this article's intention to provide a detailed explanation of every single one of these illnesses at this time. In posterior posts, there will be further elucidation. For now, hypertension and diabetes will be the focus. In a post by the KWTT team titled Understanding Blood Pressure & Dialysis Plus Free Blood Pressure Log Download, hypertension and its classification have been outlined concisely as well as preventative measures and dietary and lifestyle modification guidelines. It is recommended that the information provided is read and understood.
Controlling your blood pressure ensures you are not a candidate of Chronic Kidney Disease.
Diabetes occurs when the pancreas doesn’t adequately supply sufficient insulin to cause glucose to be absorbed from the bloodstream into cells. Often times the pancreas does secrete adequate levels however, the mechanisms that ensure that the glucose is absorbed correctly on a cellular level falters. Each cell within the body needs energy in the form of glucose (extracted from carbohydrate-rich foods) to function optimally. If cells are not able to absorb glucose optimally, this results in a rise in glucose levels within the blood, and if this happens repeatedly and over a protracted period of time it will cause long-lasting and permanent damage to many organs throughout the body such as the brain, the liver, blood vessels, hands and feet and of course, the kidneys. Glucose is naturally reabsorbed by the proximal tubule of the nephron in the kidneys. (Figure 3). If there is damage to the glomeruli which first comes into contact with blood to be filtered, there is a falter in this reabsorption by the nephrons and this contributes to the sedimentation issues outlined as well. Glucosuria is glucose in the urine.
Protein and Glucose should be present in very minimal to non-existent levels within the urine. Human bodies thrive on protein and glucose.
Remember, chronic kidney disease leads to end-stage renal failure. As the name suggests the kidneys
are at their final stages of functionality. They no longer have the capacity to function and the patient will
need dialysis (hemodialysis or peritoneal dialysis) to prolong life and keep the body healthy and
chemically balanced. The moment a person enters ESRD, their nephrologist should introduce kidney
transplant options with the patient. Hemodialysis doesn’t cure the disease, it replaces the job of the
failing kidneys. There are stages of Chronic Kidney Disease seen below, and End Stage Renal Disease is
the finality of Chronic Kidney Disease.
Stages 1-5
Stage 1 with normal or high GFR (GFR > 90 mL/min)
Stage 2 Mild CKD (GFR = 60-89 mL/min)
Stage 3A Moderate CKD (GFR = 45-59 mL/min)
Stage 3B Moderate CKD (GFR = 30-44 mL/min)
Stage 4 Severe CKD (GFR = 15-29 mL/min)
Stage 5 End Stage CKD (GFR <15 mL/min)
End-stage renal disease is diagnosed by creatinine clearance, the glomerular filtration rate <15ml/min, kidney biopsy, and analysis of the urine to determine sedimentation abnormalities. The complications of Chronic Kidney Disease include but are not limited to; Anemia, brittle bones, metabolic acidosis, high blood pressure, nerve damage, hyperkalemia (high calcium), hyperphosphatemia ( high phosphate), edema (fluid build-up). The management and Treatment of ESRD is hemodialysis until transplantation of
a new kidney is possible. Kidney transplants are best performed using a compatible living donor kidney.
In the event that a living person is not sourced, deceased donors are procured. The patient is placed on a list and receives a compatible match. This process is not as simple as it sounds as there are many laboratory tests and studies which need to be done as precursors to performing the operations. This will be discussed in posterior posts.
In conclusion, chronic kidney disease leads to end-stage renal failure and its causes are primarily HTN
and diabetes. The glomerulus as the first filtration segment of the nephron in kidneys, filters blood and the classification of CKD is based on the extent of the damage caused by the outlined etiologies persisting for more than 3 months along with other outlined diagnostic factors.
** The writer and/or KWTT does not own the rights to any of the photos provided in the figures. **
"Jodi-Ann Johnson is an author and dedicated member of the medical community. Her special interest in kidney failure stems from a family member undergoing dialysis due to end-stage renal disease and who is a prospective kidney donor recipient. She understands how delicate and difficult this journey for those battling with kidney disease can be. Also, medical terminologies can oftentimes be a hindrance to understanding by the general population. This is why she is a contributor to this platform, to provide a simplified and accessible explanation of medical information already available. May the writings serve as an act of easing the load for anyone who needs to understand these illnesses in a tangible way, what they are and how they manifest themselves in the body as well as the best treatment strategies. This should not in any way substitute obtaining medical advice from your health care provider but serves only as further education. In other moments of her life, she enjoys traveling, hiking, music, church, learning languages, and quiet times with family. "
*Note: The author chose to use an avatar instead of their real photo*
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